Shrine Hospitals Grow While Beds Stay Empty

The Shrine in 1985 opened a $22 million children's orthopedic hospital in Tampa though about 40 percent of the beds in its other orthopedic hospitals sat idle.

It was built despite a trend among pediatric orthopedic hospitals to provide general care. Children's orthopedic hospitals, including the Shrine's, have faced a diminishing need for specialized services because of the virtual elimination of polio and advances in other orthopedic treatment.

While need has been reduced, the worth of an endowment from which Shrine hospitals operate almost tripled in the last 10 years. At $700 million in 1976, the endowment increased to $1.9 billion by 1985 because of increased giving. Interest of $122 million earned by the endowment in 1985 was enough to pay the cost of running the hospitals that year.

The Shrine operates 19 orthopedic and three burns hospitals. The Tampa facility, on a hillside above a lake at the University of South Florida, is state-of-the-art for orthopedics. Shriners said it was needed because of population growth in Florida and Georgia.

Shrine spokesman Robert Turley, a Lexington, Ky. attorney, said though the Shrine has discussed going into general care, ''We have not thought it appropriate. We think there is a continuing need for specialty hospitals.''

As part of its program of specialty care, the Shrine may soon announce a program to expand into neurosurgery. Its hospitals already have begun research into the use of electrical implants in spinal cord injury cases.

Dr. Frank Stelling, former director of medical affairs for Shrine hospitals, said the orthopedic hospitals are ''just as important and in some instances more so today than they have ever been.''

''We are doing more sophisticated hospital procedures for scoliosis and other ailments. We are taking care of some difficult skeletal problems associated with cerebral palsy and spina bifida that require a very high risk type of treatment.''

Stelling, who still advises the Shrine, said the hospital system cannot support expansion. ''It would mean cutting back,'' he said. ''They would rather do the most they can in the area of orthopedics than try to get into the larger area of total care.''

Shrine hospitals are a ''national treasure,'' according to Dr. Fred Featherstone of the American Academy of Orthopedic Surgeons. Medical experts acknowledge the orthopedic hospitals' excellent work, but some say they could be more effective by offering more services.

''Based on need, the Tampa hospital should not have been built,'' said Gary Silver, executive director of the West Central Florida Health Council and a member of one of the state committees that reviewed the hospital's 1982 application.

However, Silver said anyone voting against the project, including himself, ''would have been a fool'' because Shriners take care of poor children with orthopedic problems for free. He said need was never an issue in the review process.

Silver's committee and the Florida Department of Health and Rehabilitative Services approved the Tampa project though they found neither a compelling reason to build nor a long-range plan.

''The need for orthopedic care for crippled children is limited,'' he said. ''With all their money, the Shrine should consolidate orthopedic services and expand . . . to provide more general care to the needy.''

Silver said he made that suggestion to the Shrine in 1982. ''I told them that there are terrible needs out there that the Shrine could meet, such as providing the indigent with general health care,'' he said.

THE REASON FOR BEING

Shrine and other children's orthopedic hospitals were opened to treat polio. The Shrine founded its first hospital in 1922 in Shreveport, La. Within five years it built 14 more. Hospitals were added in 1945 in Mexico City and in 1952 in Los Angeles and Houston.

Polio once was as little understood and as incurable as AIDS is today. An acute infectious disease, polio crippled children and terrified communities. In 1916 there were 27,000 cases and 7,200 deaths. An epidemic that began at the turn of the century lasted until development of the vaccines in the mid- 1950s.

Until then, polio victims commonly were hospitalized for a year or longer. But by 1970 the average stay at the Shrine's Minneapolis hospital had dwindled to 65 days. In 1985 it was 11.

Shrine bed occupancy fell from 71 percent in 1976 to 59 percent in 1980, according to a Houston consulting firm, Robert Douglass Associates, hired by the Shrine.

Some Shrine hospitals responded by expanding outpatient services and reducing beds. Shreveport cut from 60 to 45, Greenville, S.C., lost two of 62, Salt Lake City cut from 45 to 40, St. Louis from 80 to 76 and San Francisco from 50 to 40. That eliminated 36 beds, but 40 were added when the Tampa hospital, with a 60-bed capacity, opened.